Pengaruh Preventif Multimodal Analgesia Terhadap Dinamika Kadar Il - 1β, Intensitas Nyeri Pada Pascabedah Laparotomi Ginekologi

*Muhammad Hisyam  -  Bagian Anestesiologi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Universitas Hasanuddin, Indonesia
Burhanuddin Bahar  -  Bagian Anestesiologi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Universitas Hasanuddin, Indonesia
Muhammad Ramli Ahmad  -  Bagian Anestesiologi, Perawatan Intensif dan Manajemen Nyeri, Fakultas Kedokteran, Universitas Hasanuddin, Indonesia
Published: 1 Jul 2013.
Open Access
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Abstract
Latar Belakang: Nyeri pascabedah merupakan permasalahan sangat penting yangdihadapi pasien pascabedah. Meskipun pengetahuan kita tentang mekanisme nyeripascabedah sudah mengalami banyak kemajuan, namun pengelolaan nyeripascabedah belum optimal dan masih sering terabaikan. Interleukin (IL) 1β adalahsalah satu sitokin proinflamasi yang kadarnya akan meningkat bila terjadi prosesinflamasi.
Tujuan: Penelitian ini bertujuan untuk membandingkan kadar IL-1β, skala NRS, padakelompok yang mendapatkan epidural bupivakain 0,125% kombinasi parecoxib 40 mgdengan kelompok yang mendapatkan epidural bupivakain 0,125% yang digunakansebagai multimodal preventif analgesia pascabedah laparotomi ginekologi.
Metode: Penelitian eksperimental dilakukan secara acak pada 50 pasien denganstatus fisik (ASA PS) II yang akan menjalani prosedur laparotomi ginekologi dengananestesi epidural. Subyek penelitian dibagi dalam dua kelompok perlakuan, yaknikelompok pertama dengan kombinasi parecoxib 40 mg (n=25) dan kelompok keduadengan kombinasi plasebo NaCl 0,9% (n=25). Kedua kelompok tersebut mendapatkananestesi epidural selama operasi dan sebagai analgesia pascabedah. Pengambilansampel darah pasien dilakukan 35 menit sebelum pembedahan untuk pengukurankadar IL-1 β, selanjutnya dilakukan pada 2 jam dan 24 jam pascabedah. Analisisstatistik menggunakan uji Mann-Whitney U dan Levane test.
Hasil: Rerata kadar IL-1β prabedah pada kelompok parecoxib 1,05±1,25 pg/ml, 1,24± 1,54 pg/ml untuk 2 jam pascabedah dan 1,82 ± 2,16 pg/ml pada 24 jam pascabedah.Kelompok kontrol, kadar IL-1β prabedah 1,65±1,69 pg/ml, 2,55±2,77 pg/ml untuk 2jam pasca bedah pg/ml, dan 1,96±1,97 pg/ml pada 24 jam pascabedah. Tidak adaperbedaan bermakna rerata skor NRS diam dan bergerak 2 jam, 12 jam, dan 24 jampascabedah diantara kedua kelompok sampel (p>0,05).
Kesimpulan: Kombinasi epidural bupivakain 0,125% dengan parecoxib 40 mg dapatmenurunkan kadar IL-1β pada 2 jam pascabedah.
Keywords: bupivakain; epidural; IL-1β; laparotomi ginekologi; parecoxib

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Article Info
Section: Penelitian
Language: ID
In Vol 5, No 2 (2013): Jurnal Anestesiologi Indonesia
Statistics: 635 611
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